A literature review on precautionary measures in dental practice during the pandemic: Covid-19

Precautionary measures to be taken in the pandemic time

Initially one should go for tele dentistry that includes, tele screening tele consulting is highly recommended that should be the primary point of contact between the patient and the dentist. Detailed medical history from the patient should be gathered like information about fever, cough, breathlessness, chills, sore throat, runny nose, diarrhea, lethargy, weakness. If any of the above reply is yes to the above said, the appointment should be delayed for atleast three weeks until there is no dental emergency. ^[20], ^[21] In case if patient need analgesics or antibiotics can be prescribed to the patient through tele dentistry itself by the dentist, till the appointment is not scheduled to the dental clinic. During the spread of the corona virus time all the nonessential things like dental models, brouchers, magazines should be removed as is taken as potentiate surface for the spread of the disease. In the patient waiting area the chairs should be placed at a six feet distance to each other to avoid gathering of the patient. ^[22] Patient , staff should be asked to hold off accessories like bracelet, chains, necklace to avoid surface contamination of the objects. Sanitization, disinfection of the area must be assured by the dental staff to prevent the spread of the virus. ^[22]

In office visit protocol should be maintained properly by the patient as well as by the dental staff. Prior to the visit of the patient to the dental clinic his/her appointment should be confirmed the dental clinic itself telephonically. No other person is allowed to vicit the clinic other than the patient itself exception should be given to children or people with special need. Before entry in to the dental office hand sanitization should be done to the patient, mask should be provided to the patient as well as to the dental staff, before entering in to the dental clinic temperature of the patient should be monitored. ^[22] In operatory preparation one should use high efficiency particulate air filter that is commonly present in air purifiers and are portable. ^[23]

Hand sanitization should be performed on regular intervals by the dental staff as well as to the patient also before entering the dental office. Hand wash is very crucial when one is coming in contact with surfaces, equipment’s, patients. Touching nose, mouth, head, and eyes with the bare hands should be strictly restricted and must be avoided. Soap or alcohol based hand rub should be used for the purpose of sanitization. ^[24]

Mouth rinse should be used before even checking the oral cavity for the diagnostic purpose. The efficacy of chlorhexidine mouth wash in eliminating the covid-19 virus is a matter of conjecture. ^[24], ^[25] Studies revealed the use of povidone mouth wash is promising one to eliminate the virus. ^[26] Another study revealed that use of povidone mouth wash along with povidone nasal spray is very much helpful in reducing the spread of aerosol generated during high speed dental procedure. ^[27]

Use of personal protective equipment by the dental staff while doing any procedure during this time is very much helpful as well as required to prevent the spread of the disease via aerosol generated during the procedure. These aerosols generated are contaminated with the saliva of the patient and can transmit the virus to the dental operator as well as to the other dental staff. So the patient should be asked to place the surgical mask covering his/her mouth along with nose as soon as the procedure is completed and as well as when the patient entered the dental clinic. ^[28]

Filtering the contaminated air in the dental office is very much required as well as essential to prevent the spread of the disease. Different types of filters can be used to filter the air like high volume evacuator and high efficacy particulate arrestor. HVE is quite inexpensive and help in filtering of air by 90 percent at 2.83 m³ per minute. However the other device i.e. HEPA is quite expensive and can filter the air at 99.97 percent of 0.3 µm particles. CDC proposed the use of HEPA air filters during any procedure that result in aerosol generation. ^[28]

Surface disinfection is very much essential in the dental office, as it was stated that viral particle have the capability to remain on the surface for upto 9 days. So maintaining proper disinfection of the dental office surface is mandatory to inhibit the spread of the disease. Chemicals like ethanol with concentration of 67 to 71 percent, hydrogen peroxide with concentration of 0.5 %, 0.01% sodium hypochlorite i.e. 0.1g/L within a minute should be used for the process of disinfection. ^[29]

Proper disposal of ppe kit should be followed in a specific color coded bag. Face shield, eye protective glass ware should be properly disinfected with disinfection or if possible autoclave. ABHR must be used after treatment of every patient. Follow up of the patient must be there, to check any symptoms for the same.